Chapter Thee: The Intervention and Assessment Models ©2013, Brooks/Cole Cengage Learning

Triage Assessment System Evaluates the severity of a crisis situation. Rapid Systematic Intentional Supports the client in gaining: Equilibrium Mobility Autonomy ©2013, Brooks/Cole Cengage Learning

Hybrid Model of Crisis Intervention No longer a linear or stage model. Hybrid Model = linear + systems models. Can be linear or circular Tasks are the foundation Predispositioning/Engaging Problem Exploration Providing Support Examining Alternatives Planning in Order to Reestablish Control Obtaining Commitment Follow-up ©2013, Brooks/Cole Cengage Learning

Task 1: Predispositioning/Engaging Clients may not want to talk or may be so out of control that they are not even aware of the crisis worker’s presence. Engage in such a way that clients will be receptive to intervention. Establish a therapeutic bond Inform the client about what to expect ©2013, Brooks/Cole Cengage Learning

Task 1 Cont. How to Engage: Approach slowly, calmly, and with open body language. Introduce yourself and ask their name. Use their name and maintain eye contact. Use basic listening skills and open-ended questions. Clarify intentions. Allow client to cathart without escalation. ©2013, Brooks/Cole Cengage Learning

Task 2: Problem Exploration Define the problem from the client’s point of view. May be difficult during the middle of a chaotic situation Do not need a complete history Do need to identify the precipitating event ©2013, Brooks/Cole Cengage Learning

Task 3: Providing Support Communicate concern for the client. Three types of support: Psychological support Unconditional positive regard Logistical Support Physical support (food, water, shelter, etc.) Education Resources Social Support Examine the client’s primary support system May not have the resources May not be easily accessible May not be willing Client may be too embarrassed to seek help ©2013, Brooks/Cole Cengage Learning

Task 4: Examining Alternatives Clients often think they have no options or develop tunnel-vision. Three key components: Situational supports Coping mechanisms Positive thinking patterns Brainstorm numerous alternatives. Continuous process due to rapidly changing conditions ©2013, Brooks/Cole Cengage Learning

Task 5: Planning in Order to Reestablish Control Creating a plan includes: Identifying resources for immediate support Develop coping mechanisms A good plan needs to be: Developed by the client Clear Realistic Behaviorally specific Immediate (minutes, hours, or days) A plan allows the client to establish autonomy and become mobile. ©2013, Brooks/Cole Cengage Learning

Task 6: Obtaining Commitment If Task 5: Planning was done effectively, obtaining commitment may be easy. May be simply having the client verbally summarize the plan. If lethality is involved, a commitment may need to be written and signed by both parties. If there is any hesitation, the crisis worker may need to revisit earlier tasks. No commitment should be imposed by the crisis worker! ©2013, Brooks/Cole Cengage Learning

Task 7: Follow-up Time frame of minutes, hours, or days. Inquire about the client’s ability to maintain mobility and equilibrium. Reinforces the crisis worker’s support of the client. ©2013, Brooks/Cole Cengage Learning

Assessing Continuous throughout crisis intervention. Allows the crisis worker to evaluate: Severity of the situation Client’s emotional, behavioral, and cognitive status Client’s level of mobility Safety (client’s, self, and others) Success of the crisis worker in deescalating the situation ©2013, Brooks/Cole Cengage Learning

Factors That Impact One’s Emotional Stability The duration of the crisis event. The degree of emotional stamina. The ecosystem in which the client resides. The developmental stage of the client. ©2013, Brooks/Cole Cengage Learning

Psychobiology Related to Crisis Intervention Traumatic events may impact the: Release of neurotransmitters Central and peripheral sympathetic nervous systems Hypothalamic-pituitary-adrenocortical axis Abnormal changes in neurotransmitters are involved in mental health disorders. Both legal and illegal drugs have a major affect on mental health. ©2013, Brooks/Cole Cengage Learning

Triage Assessment Form (TAF) Effective method of obtaining a real-time assessment of the client’s affective, behavioral, and cognitive statuses. Can be performed quickly by a wide spectrum of trained crisis workers. Police officers School counselors Volunteer crisis line workers Resident hall staff Informs the crisis worker of the current state of the client and of their own ability to deescalate the situation. ©2013, Brooks/Cole Cengage Learning

Do You Know Your ABC’S? Three main domains of triage assessment Affective Feeling or emotional tone Behavioral Action or psychomotor activity Cognitive Thinking patterns ©2013, Brooks/Cole Cengage Learning

Affective State Often the first sign of disequilibrium. Can manifest as overly emotional or withdrawn. Incongruences among what the client says, how it is said, and non-verbal behaviors. Key question to ask: Do people typically show this kind of affect in situations such as this? ©2013, Brooks/Cole Cengage Learning

Behavioral Functioning Focus on psychomotor activities. Approaches Avoids Paralyzed Often difficult for immobilized people to take independent actions. Attempt to have the client engage in a small concrete and immediate activity. Key questions to ask: In the past, what actions did you take that helped you get back in control? What would you have to do now to get on top of the situation? ©2013, Brooks/Cole Cengage Learning

Cognitive State Client’s thinking patterns: Rationalizing? Exaggerating? Downward spiral? Crisis events are typically perceived as either a: Transgression (present) Threat (future) Loss (past) Key questions to ask: How long has the client been engaged in crisis thinking? How open is the client to reframing? How often does the client engage in crisis thinking? ©2013, Brooks/Cole Cengage Learning

Rating Clients using the TAF Score from high to low to rule out more severe impairments. Each domain has a range from 1-10 (1=lowest score and 10=highest score). Total rating ranges from 3-30. Total score of 3-10 is a rating of minimal impairment Total score of 11-19 is a rating of moderate impairment Total score of 20+ is a rating of severe impairment ©2013, Brooks/Cole Cengage Learning

TAF Rating Using the sample case of Leron from the textbook, how would you score Leron using the TAF . . . When Leron first exits Union Avenue? When the CIT officer initially meets Leron? When Leron agrees to leave the scene and gets into the police car? When the CIT officer is following-up with Leron at the legal aid office? ©2013, Brooks/Cole Cengage Learning